Introduction: Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors potentially associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of the present study was to determine risk factors for recurrence of chronic subdural hematoma after surgery.
Methods: Time-to-event (recurrence) analysis was performed to evaluate the risk factors for CSDH recurrence, using Kaplan–Meier curves. The recurrence interval (day) was transformed to the natural log to normalize distributions for all analyses in the recurrent group. We presented the multivariable hazard ratios for risk factors for recurrence of CSDH.
Results: We finally analyzed 756 consecutive patients retrospectively with CSDH who underwent burr hole surgery in the Department of Hanyang University Medical Center (Seoul and Guri) from January 1, 2004 to December 31, 2014. During the 6-month follow up period, we identified 99 patients (13.1%) with recurrence after surgery for CSDH. Thirty-one patients (31.3%) were 75 years or older, and there were 32 patients (32.3%) with BMI =25.0 in the recurrence group. Independent risk factors for recurrence were as follows: 75 years or older age group (HR,1.85; 95% CI, 1.08 to 3.17; P=0.026); obese group (BMI =25.0) (HR,1.74; 95% CI, 1.02 to 2.96; P=0.043); and bilateral operation group (HR,1.77; 95% CI, 1.10 to 2.87; P=0.019).
Conclusions: We demonstrated the risk factors for recurrence of CSDH. Further studies are needed to account for these observations and determine their underlying mechanisms.
Patient Care: If we find out the risk factors for recurrence of chronic subdural hematoma, we able to educate patients.
Learning Objectives: By the conclusion of this session, participants should be able to educate the risk factors for chronic subdural hematoma patients after surgery.
References: 1. Chari A, Hocking KC, Broughton E, Turner C, Santarius T, Hutchinson PJ, et al: Core Outcomes and Common Data Elements in Chronic Subdural Hematoma: A Systematic Review of the Literature Focusing on Reported Outcomes. J Neurotrauma:2015 Available: http://online.liebertpub.com/doi/10.1089/neu.2015.3983. Accessed 5 March 2016
2. Choi W-J, Han S-H: Blood Cadmium Is Associated with Osteoporosis in Obese Males but Not in Non-Obese Males: The Korea National Health and Nutrition Examination Survey 2008–2011. Int J Environ Res Public Health 12:12144–12157, 2015
3. Chon K-H, Lee J-M, Koh E-J, Choi H-Y: Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir (Wien) 154:1541–1548, 2012
4. Fukuhara T, Gotoh M, Asari S, Ohmoto T, Akioka T: The relationship between brain surface elastance and brain reexpansion after evacuation of chronic subdural hematoma. Surg Neurol 45:570–574, 1996
5. Guha D, Coyne S, Macdonald RL: Timing of the resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study. J Neurosurg 124:750–759, 2015
6. Jang SY, Shin Y-I, Kim DY, Sohn MK, Lee J, Lee S-G, et al: Effect of obesity on functional outcomes at 6 months post-stroke among elderly Koreans: a prospective multicentre study. BMJ Open 5:e008712, 2015
7. Jung Y-G, Jung N-Y, Kim E: Independent predictors for recurrence of chronic subdural hematoma. J Korean Neurosurg Soc 57:266–270, 2015
8. Kutty SA, Johny M: Chronic subdural hematoma: a comparison of recurrence rates following burr-hole craniostomy with and without drains. Turk Neurosurg 24:494–497, 2014
9. Mori K, Maeda M: Surgical treatment of chronic subdural hematoma in 500 consecutive cases: clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir (Tokyo) 41:371–381, 2001
10. Ohba S, Kinoshita Y, Nakagawa T, Murakami H: The risk factors for recurrence of chronic subdural hematoma. Neurosurg Rev 36:145–150, 2012
11. Oh H-J, Lee K-S, Shim J-J, Yoon S-M, Yun I-G, Bae H-G: Postoperative Course and Recurrence of Chronic Subdural Hematoma. J Korean Neurosurg Soc 48:518–523, 2010
12. Pang CH, Lee SE, Kim CH, Kim JE, Kang H-S, Park C-K, et al: Acute intracranial bleeding and recurrence after bur hole craniostomy for chronic subdural hematoma. J Neurosurg 123:65–74, 2015
13. Raji CA, Ho AJ, Parikshak NN, Becker JT, Lopez OL, Kuller LH, et al: Brain structure and obesity. Hum Brain Mapp 31:353–364, 2010
14. Torihashi K, Sadamasa N, Yoshida K, Narumi O, Chin M, Yamagata S: Independent predictors for recurrence of chronic subdural hematoma: a review of 343 consecutive surgical cases. Neurosurgery 63:1125–1129; discussion 1129, 2008
15. Yi S-W, Odongua N, Nam CM, Sull JW, Ohrr H: Body Mass Index and Stroke Mortality by Smoking and Age at Menopause Among Korean Postmenopausal Women. Stroke 40:3428–3435, 2009